HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: i
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PRQPOSED 1MIPR01/EI�I!ENT L®CATIaN:
Address:
Legal Description:
oe
Property Tax ID# — Lot No.
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Site Plan Name: kz
Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED D'E�SCRTPTIQ'N
CQ'NSTRUCTIO'N N. F.-B®RHUMVY, IN—
itional work to bnerformied under tispermit—check all appy:
1_1HVAC Gas Tank []Gas Piping _Shutters a Windows/Doors
Electric ❑ Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ / /,�� Utilities:0 Sewer 11 Septic Building Height:
@ NER/LESSEaE: CONTR40i R:
Name Name:
Address: ti` "Com an /
'City: _ State:
kAddr'es
Zip Code. Fax. '
``City � State:lobe
Phone N'd.-- a
i
E-Mail: Phone No.
Fill in fee simple Title Holder on next page(if different E-Mail:
from the Owner listed above) State or County License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
5 !PPLENIENTAL C� NS¢TR�UC�TID,N LI'�EN LAVU INF®R3fUiP►TION.:
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DESIGNER�ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit, I do hereby agree that I will,in all respects, perform the work
in accordance with the approved plans,the Florida Building Codes and St. Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review: room additions,
accessory structures,swimming pools,fences,walls,signs,screen rooms and accessory uses to another non-residential use
WARNING TO OWNER:Your failure to Record a Notice of Commencement may result in your paying twice for
improvements to your property.A Notice of Commencement must be recorded and posted on the jobsite
before the first " pection. If you intend to obtain financing, consult with lender or an attorney before
c cin or or recording our Notice of Commenceme
s
ignatur of 0 ner/L ssee ent S' nature of ontra tor/ 'tens older
STATE OF ORI A /STATE OF FLORI A
COUNTY OF COUNTYc
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day ofZTU' K!4— 201.5 by this day of s�Q® 20 by
1
(Name of persGh acknowle ing) (Name of person ac owledging)
ature of Notary Public- tate of Florida) (Signature of Notary Publi State of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. ..ti r;., M Commission No.
LASHAHNA INGRANI
My Comm.ExpiRtJOt2iy,PotatKitc--�f�teMf�+A6ldaa
�.',• r°. ti Notary Public-State of Florid
• �= _•. a•E y omm. xpi
a. Commission#qR lV
Revised 07/15/201 •"' �`' "r a:= Commission#FF 177249
rfi��`' Bonded through National Notldrygh "'� oma:••
Bonded through National Notary As .
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS